The Mental Health Crisis

I often hear or read people describing our mental health system being in a state of crisis. I take these comments to heart as a provider of mental health services. And it should bother all of us. I am a licensed professional counselor and I work in an emergency room as a psychiatric social worker and as an outpatient therapist. I have an intimate understanding of our mental health system and I have many thoughts on what is working and what needs some attention. However, I want to focus on only a few high-level thoughts for this article from the perspective of a provider.

In my opinion, COVID amplified an issue that was already present. This pandemic exacerbated the symptoms of depression, anxiety, fear, and other symptoms that people were already dealing with. Within the past two years, from my own experience, the hospital I work for has seen dramatic increases in ER visits for psychiatric and substance use concerns (especially with adolescents). The outpatient clinic turns away dozens of patients every week who are seeking therapy. There just is not enough time in the day to help everyone that calls unfortunately. With the influx of people seeking help and the increased difficulty getting treatment quickly, people have resorted to going to the ER. Wait times have increased and hospital length of stays for patients in need of higher levels of care have also increased due to the lack of psychiatric hospital beds across the state.

As I discussed in a previous article, therapists and other mental health providers are experiencing compassion fatigue. A person can only provide so much empathy and compassion before needing time to recharge and refuel. But with the demand for treatment being so critical, many clinicians I know are overbooking and not taking care of their own mental health. Not only are therapists providing care to more people with increasingly severe symptomology, but we are frequently reminded that the system is “broken”. I do not mean for this to be self-serving, but for all those providing care to those in crisis, we are constantly reminded that the system fails people. That it is not sufficient. And truthfully, some of us internalize this and it causes low self-esteem, increased fatigue, and lack of satisfaction. This has led to people changing careers and thus adding to the growing problem of accessing care.

But, you’re right. The system is not perfect. I know the common talking point is mental health is underfunded and while I agree, the allocation of funds needs to go to the right places. I believe that it starts with communication and a basic understanding of mental health. It starts in schools for young students. It’s important to learn about anxiety, depression, and how to process emotions. It starts at home. Those tough conversations with our loved ones. It’s ok to have high (and realistic) expectations for ourselves and our loved ones. It starts in group homes with appropriate behavioral interventions to minimize risk and reduce trips to the ER. It starts in lower levels of care to provide services specifically focused on reducing inpatient hospitalizations. It starts with compliance with services and medication. The list goes on and on, but the focus and emphasis needs to be on accessibility to care.

I understand there are a lot of politics involved here. But it does not need to be difficult. The more services that are available to people to easily access, the burden on the system will be reduced. Regardless of insurance, there needs to be a streamlined process for accessing care. I am not suggesting universal healthcare, I am saying we as providers, or the lawmakers, or those with power to enact change, we need to put ourselves in the shoes of those seeking help. It should not take days, weeks, or even longer for people in crisis to find out where their insurance is accepted. For example, someone with Medicare who is in need of substance use treatment in Michigan could spend weeks calling facilities without any success. There are very few IP programs who work with Medicare consumers for substance use treatment. People who are turned away repeatedly are at elevated risk to stop seeking help.

I am recommending that we simplify the process. Money needs to be allocated to promote case management services to help people connect with the correct providers. The faster someone receives help, the chances of success increase. It could also reduce recidivism if someone receives the proper help early. Quality care is out there, but people can not always find it. I see it on a daily basis. So many people could have avoided an ER admission had they known where to go, or had they known who to call before they hit rock bottom.

I know these are idealistic solutions, but I wanted to take an opportunity to look at this problem from a macro perspective. There are so many people in need of treatment, therapy, and behavioral health interventions and the providers are overwhelmed. We need to continue having these discussions about mental health. The stigma still exists and misconceptions about mental health are still abundant. I will be the first one to tell you that I am not always emotionally regulated. And that is OK! As a parent, my wife and I want to normalize mental health by having these discussions. I want my kids to have the courage to talk about how they feel.

A common theme I see with the adolescent population remains with reliance on social media, cyberbullying, and lack of communication within the home. I understand that I see families on one of their worst days so my perception may be skewed. I have started asking kids more about their family structure in my assessments. I have found that kids want rules. It takes a creative way of asking, but they want to be held accountable. They want dinner time with the family. All people thrive with stability and kids are no different. Kids are telling me that their primary source of support are friends who often only communicate via social media. This is concerning as I saw a grown man on Twitter last night tell someone to kill themselves for having a differing opinion about fantasy football. If this is what kids are constantly seeing, it is obvious a problem exists.

I attended a conference on mental health for adolescents a few weeks ago and a topic discussed in a seminar was about the importance of dinner time. It really stuck with me. It allows the family to get together and talk. Like actually talk. Usually dinner is not a place where we as parents are yelling about incomplete homework or the house being dirty. It’s a time when we can interact with our loved ones. And if we notice that someone within the family is struggling, especially over the course of a few days, we have the ability to talk about it and intervene before it escalates.

My primary message is that the mental health system is under a lot stress. Therapists are tired and frustrated. And those seeking help are tired and frustrated. Funding is needed. Support is needed. But it starts with us. It starts at home. Be kind to others, and be kind to yourself. And talk about your emotions and make it normal. It’s ok to not be ok! Take care and be well.